每日一题_2023.01.16

A 45-year-old man goes to his primary care physician complaining of recent headaches. They rarely persist for more than an hour, but are sporadic and often accompanied by sudden sweating and palpitations. “Doc,” he says, “it feels like my heart is racing.” Acetaminophen provides minimal relief from the pain. He is afebrile and his blood pressure is 128/70 mm Hg. His physical examination is unremarkable with the exception of moist palms and pale skin. A urinalysis is notable for elevated metanephrines. This patient’s most likely diagnosis is often associated with which of the following conditions?

一名 45 岁的男子因最近头痛而去看初级保健医生。 它们很少持续超过一个小时，而是零星的，常伴有突然出汗和心悸。 “医生，”他说，“感觉我的心在狂跳。” 对乙酰氨基酚对疼痛的缓解作用很小。 他没有发热，血压为 128/70 mm Hg。 除了潮湿的手掌和苍白的皮肤外，他的身体检查没有异常。 尿液分析显着升高的变肾上腺素。 该患者最可能的诊断通常与以下哪种情况有关？

(A) Hashimoto thyroiditis 桥本氏甲状腺炎

(B) Insulinoma胰岛素瘤

(C) Parathyroid tumor 甲状旁腺肿瘤

(D) Prolactinoma泌乳素瘤

(E) Zollinger-Ellison syndrome佐林格-埃里森综合症

答案解析：

其他方面健康的男性出现间歇性头痛、出汗和心悸提示嗜铬细胞瘤，这是一种最常见于肾上腺的分泌儿茶酚胺的肿瘤。 发作的持续时间有限，但这些事件期间的血压可能达到危险的高水平。 高尿儿茶酚胺、变肾上腺素和香草扁桃酸可确诊。 作为 MEN II 型综合征的一部分，嗜铬细胞瘤与甲状旁腺肿瘤相关，其中还包括甲状腺髓样癌。

正确答案：C